Pressure Masks for Facial Scar Treatment after Oncological Reconstruction: Long-Term Patient Satisfaction and Quality of Life.

INTRODUCTION: With increasing incidence of facial skin cancer, more patients undergo facial reconstruction following Mohs micrographic surgery (MMS). Aesthetically unpleasing, thickened facial flaps, and disturbing scars can be treated with a pressure mask with inner silicone lining to help improve functional and aesthetic outcomes. However, data on long-term patient satisfaction and quality of life (QoL) following this treatment are lacking. METHODS: We aimed to assess long-term satisfaction and QoL of patients who underwent local flap reconstruction following MMS. Patients treated between January 2012 and October 2020 were invited to answer FACE-Q and SCAR-Q questionnaires. Demographic data, skin cancer type and location, type of reconstruction, postoperative complications, duration of pressure mask therapy, daily compliance, and additional scar treatment were collected to explore possible predictors. RESULTS: Of 92 eligible patients, 50 responded. Eighteen respondents were male (36%) and 32 were female (64%). Mean duration of pressure mask therapy was 10.20 ± 4.61 months. Patients were 61.14 ± 32.91 months after completion of pressure mask therapy upon participation. Patients whose reconstruction consisted of multiple flaps had significantly worse outcomes in social function (p = 0.012), scar appearance (p = 0.045), and scar symptoms (p = 0.008). A trend of increasing time since therapy completion predicting better outcomes was observed for all scales, and it was a significant predictor for better scar appearance (p = 0.001) and less scar symptoms (p = 0.001). CONCLUSION: Pressure mask treatment for facial flaps and scars following MMS results in good long-term patient satisfaction and QoL. Multiple local flaps, reflecting a larger skin defect postexcision, is a predictor for worse outcomes in social function, scar appearance, and symptoms. Increasing time is associated with increasing satisfaction, which reflects satisfactory and stable long-term effects of treatment, possibly combined with more acceptance of the result over time.

Clinical effects of transparent facial pressure masks: A literature review.

BACKGROUND: Severe facial hypertrophic scars are known to severely impact emotional well-being. Pressure therapy by means of transparent face masks has been used for almost 40 years, but evidence about the clinical effects remains sparse. OBJECTIVES: To provide a summary on the efficacy of transparent face masks in the treatment of facial hypertrophic scars. METHODS: A literature search was conducted in PubMed, MEDLINE, and Cochrane databases through 1 January 2018. Articles describing the clinical effects of facial pressure therapy for remodeling the face after trauma or surgery with a validated tool were included. This review included studies of participants treated with facial hypertrophic scars, both minors and adults. RESULTS: Three articles involving 33 patients were selected for inclusion. Two studies described statistically significant improvement in facial scars measured by durometer, ultrasound, and the Patient and Observer Scar Assessment Scale (POSAS). CONCLUSIONS: Facial pressure masks have been shown to deliver significant improvement in facial scars, measured by both subjective and objective tools. However, only three studies could be included in this literature review. Also, because of considerable limitations of the studies, it remains difficult to draw substantial conclusions about the efficacy of transparent face masks. CLINICAL RELEVANCE: This literature review provides a summary of the current evidence on the subjectively and objectively measured clinical effects of transparent face masks in the treatment of facial scars, highlighting the need for further research on this topic.

Manual fabrication of a specialized transparent facial pressure mask: A technical note.

BACKGROUND AND AIM: The objective of this study was to describe the manual fabrication of a transparent facial pressure mask for treating facial deformities. The mask combines the use of a silicone inner liner and mechanical pressure in the facial region. TECHNIQUE: A negative mold is formed by covering the face with plaster. Manipulation of soft tissue is a crucial part in this process. After hardening and removal of the negative mold, the positive mold is formed and dried. Next a rolled silicone sheet is placed over the positive mold in a vacuum environment. Subsequently, the silicones are vulcanized. Then the rigid outside of the mask is created. The silicone inner liner and outside shell are then affixed. DISCUSSION: This described technique results in accurate facemasks with precise fitting. During therapy, the mask is adjusted multiple times to keep excellent fit, as remodeling of scars and deformities takes place. CLINICAL RELEVANCE: Facemasks are a reputable therapeutic modality to reduce excessive facial scarring. They require excellent fitting to give pleasing results. To provide a better understanding of facemask therapy, this study describes the manual fabrication technique.

Duration of Scar Maturation: Retrospective Analyses of 361 Hypertrophic Scars Over 5 Years.

OBJECTIVE: Maturation remains the least understood phase of wound healing; estimates of maturation time are broad and inaccurate. A more precise estimation of maturation time could influence scar therapy and give insight to the wound healing cascade. The objective of this study was to assess the mean time between onset and complete maturation of hypertrophic scars. METHODS: This retrospective study was performed in an outpatient clinic of the Maastricht University Medical Center exclusively focused on scar treatment; 361 patients with a hypertrophic scar were included between September 2010 and December 2015. MAIN OUTCOME MEASURES: Date of onset and date of complete maturation were documented in patients' medical files. Patients were divided into three patient groups: <30 years, 30-55 years, and >55 years. Different scar causes and scar therapies were analyzed in relation to maturation time. MAIN RESULTS: These results reveal statistically significant differences (P < .05) in mean maturation time between the <30 (35.76 months) and >55 patients (22.53 months) and between >55 and 30-55 year old patients (34.64 months). Significant differences in mean maturation time were also found between scars treated with pressure therapy (23.20 months) and combination therapy (30.59 months), silicone therapy (35.51 months), injection therapy (46.43 months), and other therapies (41.31 months). No significant differences in maturation time were found relative to scar cause. CONCLUSIONS: This study shows that hypertrophic scars take significantly more time to completely maturate than previously believed, and older patients show the fastest healing. Further, scars treated with pressure therapy maturate fastest.

A new treatment for reliable functional and esthetic outcome after local facial flap reconstruction: a transparent polycarbonate facial mask with silicone sheeting.

BACKGROUND: Facial flap surgery predominantly leads to good functional results. However, in some cases, it can cause unsatisfactory esthetic results. They include persistent erythema, pincushioning, and development of hypertrophic scars. Conservative, reliable treatment for facial flaps is lacking. Pressure and silicone therapy have proven to result in significant improvement in scar erythema, pliability, and thickness in postburn hypertrophic scars. By combining these therapies in a facial mask, the esthetic outcome of facial flaps could be improved. In this retrospective study, the efficacy of a unique transparent face mask containing silicone sheets on the esthetic outcome of postsurgical facial flaps is assessed. METHODS: Twenty-one patients were assigned to facial pressure mask therapy after they underwent facial flap surgery between July 2012 and September 2015. Patients were treated for a mean duration of 46 weeks. The effects of pressure mask therapy were examined by means of the Patient and Observer Scar Assessment Scale (POSAS). RESULTS: All POSAS components showed a reduction between start and end of therapy, while itchiness, pigmentation, pliability, thickness, and relief of the flap improved significantly (P < 0.05). Mean total and patient score showed significant reduction between start and end of therapy. CONCLUSIONS: This study shows that a facial pressure mask layered with silicone results in noticeable flap improvement with a long-lasting result. Level of Evidence: Level III, therapeutic study.

Periconceptional folic acid use and the prevalence of positional plagiocephaly.

The incidence of positional plagiocephaly (PP) has increased during the last 2 decades in the Netherlands. Although this is generally solely attributed to the advice to put babies on the back during their sleep, other factors might be of influence. Because the advice to take folic acid (FA) was initiated in the same period as the sleeping advice, this study was undertaken to evaluate the effect of FA on PP. It is known that a daily intake of 400 microg of FA around the time of conception is advised in periconceptive women to prevent development of neural tube defects. The maximal daily dietary folate intake is considered to be 250 mg with a bioavailability of 50% to 70%. However, periconceptional women may take a multivitamin containing pteroylmonoglutamine in addition to a FA supplement (isolated pteroylmonoglutamine). Therefore, the daily intake of FA will exceed 1 mg daily, which is considered the upper limit of daily folate ingestion. Data from the "Maastricht Cohort and Intervention study about pregnancy related girdlepain" were used to study the amount of folate containing supplemental intake of all the 7526 women. In this study, women were prospectively questioned about their FA intake. The entire cohort, considered the control group, was compared with a subgroup of women within this cohort with children with PP, treated by a plastic surgeon, considered the PP group. Double use, defined as isolated FA preparations in addition to folate containing supplements (vitamins), was seen more frequently in women giving birth to children with PP. In the PP group, double use was seen in 33.3% of the women compared to 13.2% in the control group. Although no statistical analysis could be made because the PP group was too small, the use of too high dosages of FA might have an adverse effect in causing more PP. This article does not want to discuss the beneficial effect of FA during pregnancy. However, we observed a potential empirical relation between PP and FA double intake requiring attention in more extensive studies.

Molding therapy of positional plagiocephaly: subjective outcome and quality of life.

To evaluate quality of life (QOL) and parental satisfaction in children diagnosed and treated with molding helmet therapy (MHT) for positional plagiocephaly, a retrospective chart research was performed on 166 children who had visited the craniofacial outpatient clinic in the University Hospital of Maastricht between 2002 and 2003. Two questionnaires were sent to parents of these children. The first was used to measure QOL (TAPQOL questionnaire) and was related to a healthy control group. The second evaluated parents' satisfaction concerning the shape of their children's head before and after treatment. One hundred forty-two children were diagnosed with positional plagiocephaly. The group consisted of 111 boys (78.2%) and 31 girls (21.8%). Ninety-eight patients were treated by MHT and 44 had no treatment. Indications for treatment were an ARGENTA classification of type 3 or worse and subjective rating of head shape by the parents. Parents of all children treated with MHT were sent both questionnaires. Forty-six parents (response rate 47%) returned the questionnaires. This group consisted of 39 boys and eight girls. The healthy control group consisted of 251 children between the ages of 1 and 5 years and was used to validate the questionnaire in a previous study. There were no significant differences in QOL scores between the healthy control group and children treated with molding helmet therapy (P > 0.05). Parents gave an average rating of 3.6 before therapy and 7.5 after therapy, a difference of 3.9. Of 46 parents whose children had MHT, only two would not repeat or recommend this therapy. Reasons were unsatisfying result and, in one case, serious pressure spots with hair loss. The population in this study was similar to other studies. Results showed no difference in QOL between treated children and a healthy control group. This study showed that MHT in children with severe positional plagiocephaly does not have long-term adverse effects on QOL. Differences in subjective rating show that MHT has a good result on head shape. A 96% satisfaction rate shows that it is a pleasant therapy and gives a satisfying result.